Kim J, Sookram G, Godecke E, Brogan E, Armstrong E, Ellery F, Rai T, Rose M L, Ciccone N, Middleton S, Holland A, Hankey G J, Bernhardt J, Cadilhac D A
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
Top Stroke Rehabil. 2024 Mar;31(2):157-166. doi: 10.1080/10749357.2023.2229039. Epub 2023 Jul 6.
There is limited evidence on the costs and outcomes of patients with aphasia after stroke. The aim of this study was to estimate costs in patients with aphasia after stroke according to the aphasia therapies provided.
A three-arm, prospective, randomized, parallel group, open-label, blinded endpoint assessment trial conducted in Australia and New Zealand. Usual ward-based care (Usual Care) was compared to additional usual ward-based therapy (Usual Care Plus) and a prescribed and structured aphasia therapy program in addition to Usual Care (the VERSE intervention). Information about healthcare utilization and productivity were collected to estimate costs in Australian dollars for 2017-18. Multivariable regression models with bootstrapping were used to estimate differences in costs and outcomes (clinically meaningful change in aphasia severity measured by the WAB-R-AQ).
Overall, 202/246 (82%) participants completed follow-up at 26 weeks. Median costs per person were $23,322 (Q1 5,367, Q3 52,669, = 63) for Usual Care, $26,923 (Q1 7,303, Q3 76,174, = 70) for Usual Care Plus and $31,143 (Q1 7,001. Q3 62,390, = 69) for VERSE. No differences in costs and outcomes were detected between groups. Usual Care Plus was inferior (i.e. more costly and less effective) in 64% of iterations, and in 18% was less costly and less effective compared to Usual Care. VERSE was inferior in 65% of samples and less costly and less effective in 12% compared to Usual Care.
There was limited evidence that additional intensively delivered aphasia therapy within the context of usual acute care provided was worthwhile in terms of costs for the outcomes gained.
关于中风后失语症患者的成本和治疗结果的证据有限。本研究的目的是根据所提供的失语症治疗方法，估算中风后失语症患者的成本。
在澳大利亚和新西兰进行了一项三臂、前瞻性、随机、平行组、开放标签、盲终点评估试验。将常规病房护理（常规护理）与额外的常规病房治疗（常规护理加强组）以及除常规护理外的规定性结构化失语症治疗方案（VERSE干预）进行比较。收集了医疗保健利用和生产力方面的信息，以估算2017 - 18年以澳元计算的成本。使用带有自抽样法的多变量回归模型来估算成本和治疗结果的差异（通过西方失语成套测验修订版失语商数测量的失语严重程度的临床有意义变化）。
总体而言，202/246（82%）名参与者在26周时完成了随访。常规护理组每人的中位数成本为23,322澳元（第一四分位数5,367，第三四分位数52,669，n = 63），常规护理加强组为26,923澳元（第一四分位数7,303，第三四分位数76,174，n = 70），VERSE组为31,143澳元（第一四分位数7,001，第三四分位数62,390，n = 69）。各组之间未检测到成本和治疗结果的差异。在64%的迭代中，常规护理加强组较差（即成本更高且效果更差），与常规护理相比，在18%的情况下成本更低但效果更差。与常规护理相比，VERSE在65%的样本中较差，在成本更低且效果更差的情况中占12%。
在常规急性护理背景下额外密集提供失语症治疗在获得的治疗结果成本方面是否值得，证据有限。
